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Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010

Published online by Cambridge University Press:  12 September 2014

Yasuyuki Okumura ,
Takashi Togo  and
Junichi Fujita
Yasuyuki Okumura*
Affiliation:
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
Takashi Togo
Affiliation:
Inaho Clinic, Kanagawa, Japan
Junichi Fujita
Affiliation:
Department of Child and Adolescent Psychiatry, Kanagawa Children's Medical Center, Kanagawa, Japan
*
Correspondence should be addressed to: Yasuyuki Okumura, PhD, Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 1-5-11 Nishi-Shinbashi, Minato-ku 105-0003, Tokyo, Japan. Phone: +81-3-3506-8529; Fax: +81-3-3506-8528. Email: yokumura@blue.zero.jp.
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Abstract

Background:

We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010.

Methods:

We used data from the 2002–2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month.

Results:

In 2008–2010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (37.5%), antipsychotics (24.9%), antidepressants (13.0%), and mood-stabilizers (2.9%). Between 2002–2004 and 2008–2010, use of second-generation antipsychotics (SGAs) increased from 5.0% to 12.0%, while use of first-generation antipsychotics (FGAs) decreased from 20.6% to 12.9%. These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease.

Conclusions:

Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.

Keywords

dementiabehavioral and psychological symptoms of dementia (BPSD)psychopharmacologymental health policy
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 3 , March 2015 , pp. 407 - 415
Copyright
Copyright © International Psychogeriatric Association 2014 

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